| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19,168 |
9,567 |
$737K |
| V2020 |
Frames, purchases |
12,866 |
10,685 |
$427K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
8,366 |
8,224 |
$334K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,435 |
2,409 |
$98K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
618 |
418 |
$33K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
699 |
699 |
$28K |
| 92015 |
Determination of refractive state |
1,650 |
1,645 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
966 |
504 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,189 |
3,120 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
131 |
126 |
$7K |
| V2025 |
Deluxe frame |
534 |
510 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
180 |
173 |
$6K |
| V2744 |
Tint, photochromatic, per lens |
161 |
92 |
$4K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
86 |
43 |
$2K |
| V2781 |
Progressive lens, per lens |
42 |
26 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
25 |
$2K |
| V2299 |
Specialty bifocal (by report) |
19 |
12 |
$899.69 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$360.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$120.00 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$60.00 |